Internet‐based treatment of stress urinary incontinence: 1‐ and 2‐year results of a randomized controlled trial with a focus on pelvic floor muscle training

Abstract

ObjectivesTo evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT).Subjects and MethodsThe present study was a randomized controlled trial with online recruitment of 250 community-dwelling women aged 18–70 years with SUI ≥ one time/week. Diagnosis was based on validated self-assessed questionnaires, 2-day bladder diary and telephone interview with a urotherapist. Consecutive computer-generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet-based treatment programme (n = 124) or a programme sent by post (n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ-UI SF]) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health-specific quality of life (EQ-visual analogue scale [EQ-VAS]), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat.ResultsWe lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (P < 0.001) improvements with large effect sizes (>0.8) for symptoms and condition-specific quality of life (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group (P = 0.79) after 2 years. The mean changes (sd) in condition-specific QoL were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) (P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group (P = 0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (internet, 31.9% [28/88]; postal, 33.8% [27/80], P = 0.82), but after 2 years significantly more participants in the internet group reported this degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health-specific QoL improved significantly in the internet group after 2 years (mean change in EQ-VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 year after treatment, 69.8% (60/86) of participants in the internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the trea...

Urinary incontinence in women

“…The strongest evidence of benefit is for supervised PFMT in women with stress incontinence, with less efficacy in those with urgency incontinence 111 . Emerging evidence supports unsupervised delivery of PFMT 112 , which could be cost-effectively delivered through e-training 113 . Women are taught to consciously contract their pelvic floor muscles before and during any increase in abdominal pressure, such as coughing, to avert leakage, and simultaneously to build up the support of the pelvic floor through regular muscle strength training 114 .…”

Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year

“…The PFMT in this program is unsupervised, but, unlike studies that compare supervised and unsupervised PFMT [27, 28], the women in this study did not receive any face-to-face education by a physiotherapist during the program. Nonetheless, the women in our study population were significantly improved at 4 months, 1 year, and 2 years [13, 14]. …”

“…The improvements were maintained at the 1-year and 2-year follow-ups [13, 14]. The aim of the present study was to evaluate clinically relevant predictors of long-term success after non-face-to-face treatment focusing on PFMT in women with SUI.…”

Urinary incontinence in women

“…The strongest evidence of benefit is for supervised PFMT in women with stress incontinence, with less efficacy in those with urgency incontinence 111 . Emerging evidence supports unsupervised delivery of PFMT 112 , which could be cost-effectively delivered through e-training 113 . Women are taught to consciously contract their pelvic floor muscles before and during any increase in abdominal pressure, such as coughing, to avert leakage, and simultaneously to build up the support of the pelvic floor through regular muscle strength training 114 .…”